The association between chain characteristics, complaints and hospitalisations in residential long-term care homes: Evidence from Australia

BACKGROUND: Across many high-income countries, the ownership structures of residential long-term care (LTC) providers have come under increased scrutiny. While chain ownership is commonly recognised as a structural determinant of care quality, evidence on its effects remains mixed. Australia's highly concentrated, nationally regulated LTC system provides a useful setting to test whether effects vary by chain characteristics. OBJECTIVE: To examine the association between chain characteristics of for-profit and non-profit residential long-term care (LTC) homes, including chain affiliation, chain size and geographic clustering on the quality of care delivered in those homes. METHODS: A cross-sectional retrospective panel design was used, using de-identified datasets obtained under the legal authority of the Royal Commission into Aged Care Quality and Safety. Sample comprised 2596 unique Australian residential LTC homes between 2015 and 2019. Multivariable analyses estimated associations between chain characteristics and the rates of potentially preventable hospitalisations and complaints lodged with the national regulator, adjusting for home-specific characteristics. RESULTS: Multivariable analysis shows that homes operated by larger chains had higher rates of hospitalisations and complaints, controlling for other covariates influencing these outcomes. However, chain affiliated homes operating in a geographical clustering within Aged Care Planning Region had lower rates of preventable hospitalisations and complaints. Chain affiliation added limited additional explanatory power beyond other chain characteristics. CONCLUSIONS: These findings suggest that commonly used binary measures of chain affiliation may mask meaningful heterogeneity across providers. Policy and regulatory approaches aimed at monitoring market consolidation may benefit from considering more granular chain characteristics, particularly chain size and geographic clustering, rather than affiliation alone.